Dento-legal considerations

READING POINT! You can access the GDC’s Standards for the Dental Team at: www.gdc-uk.org/Dentalprofessionals/Standards/Documents/Standards%20for%20the%20Dental%20Team.pdf

lightbulbREADING POINT! You can read about the specific charges, findings of fact and determinations found against registrants by GDC committee members from the hearings section of the GDC website at: www.gdc-uk.org/Membersofpublic/Hearings/Pages/Hearings-list.aspx

Employment law

You will be employed by either your ES, or the practice owner, whose obligations towards you and other employed staff at the practice will already exist. These include obligations under the Health and Safety at Work etc. Act 1974. Your Foundation Contract complies with the Employment Rights Act 1996 (as amended) (Contracts of Employment and Redundancy Payments Act (Northern Ireland) 1965 as amended).

CPD

The GDC introduced continuing professional development (CPD) for dentists in 2002, which you need to participate in by law. The GDC has defined CPD as:

lectures, seminars, courses, individual study and other activities, that can be included in your CPD record if it can be reasonably expected to advance your professional development as a dentist or dental care professional and is relevant to your practice or intended practice.96

‘Verifiable’ CPD must meet specific conditions, whereas ‘general’ CPD is educational activities that are not independently verified, such as private study. Dentists must carry out at least 250 hours of CPD every 5 years in a CPD cycle, with at least 75 of these hours needing to be verifiable. Although this theoretically could mean that you could spend just 1 year of every 5 ‘clocking up’ your CPD requirements, it is recommended that your attendance is spaced out across your CPD cycle. The GDC expects dentists to complete the following three core subjects of CPD:97

  1. Medical emergencies – 10 hours per CPD cycle (works out to 2 hours each year)
  2. Disinfection and decontamination – 5 hours per CPD cycle (works out to 1 hour each year)
  3. Radiography and radiation protection – 5 hours per CPD cycle (works out to 1 hour each year).

Also, the GDC recommends accessing CPD in the following areas:

  • Legal and ethical issues
  • Complaints handling
  • Oral cancer early detection.

An understanding of the importance of CPD within dentistry and its recording is a COPDEND curriculum competency98 that you are expected to demonstrate during FT. As an FD your first CPD cycle will not commence at the point of GDC registration, but rather at the beginning of the first full calendar year following registration, i.e. from 1 January. This means that any CPD you accrue in the period between the point of registration and 31 December of that calendar year will not count towards your CPD cycle. During FT you will cover a minimum of 30 study days which, if verifiable, may mean that you could complete close to the full 75 hours expected of you within the first calendar year of your CPD cycle. This could affect your desire to complete any other verifiable CPD activities during the remainder of that CPD cycle. Therefore, it is common for your FTPD to issue you with a verifiable CPD certificate for a fixed number of hours (i.e. 25 hours) upon completion of the FT programme, which can contribute towards your CPD cycle. Of course, any verifiable CPD activities completed outside of FT in the first calendar year following registration will count towards your CPD cycle.

You must keep a record of all the CPD hours that you do, both verifiable (for which you must also keep documentary proof from the activity provider) and general. This is because every year you will be required to submit to the GDC the number of verifiable and general CPD hours completed, which can be done either online at www.eGDC-uk.org or by completing an annual declaration form. Although evidence of CPD may be requested, GDC registrants currently enjoy the privilege of self-regulation, which is accompanied by a responsibility of maintaining the highest standards of ethical practice. However, the GDC is working to introduce a system of revalidation,99 which is already mandatory for doctors. Revalidation is the process by which individuals are required to demonstrate on a regular basis that they are up to date and fit to practise.

Complaints

As a dental student you are generally sheltered from complaints and litigation, as you tend to treat patients generally at no cost, within highly supervised clinics. The culture in general dental practice, however, is different, as patients pay NHS charges, or the state does on their behalf, which acts to increase their expectations of the standard of care provided. Patients are empowered to give feedback on their dental experiences, and are quick to say when they are dissatisfied with their experience. In this regard dental practices are no different from restaurants and hotels in being reviewed and scrutinised, increasingly online. The reality is that we live in a less forgiving and more litigious climate, and this can be a scary prospect.

A complaint is generally regarded to be any expression of dissatisfaction with a service that you have provided to a patient. The GDC expect you to normally respond to a complaint in writing or by phone as soon as you receive it, if possible. If you cannot sort the complaint out immediately, you should normally send an acknowledgement within 3 working days of receiving the complaint and respond to the complaint no later than 10 working days after receiving it. This may be different, however, if there are exceptional circumstances or if you have agreed a different timescale with the patient.100 All written responses to NHS complaints need to be counter-signed by the Responsible Person in the practice who is usually the practice owner. If a complaint cannot be resolved locally then patients have recourse to the Dental Complaints Service regarding private treatment and the Parliamentary and Health Service Ombudsman regarding NHS services, where the NHS contract provider is likely to be questioned. Please note however that the Foundation Contract obliges you to comply with the NHS Terms of Service.

A 2012 survey conducted by Cardiff University revealed that 11% of the 510 trainers who responded indicated experiencing difficulties related to patient complaints about their trainee’s work or attitude.101 Receiving a complaint does not necessarily mean that you are a ‘bad dentist’ as there are many reasons why a patient would feel the need to complain. However, one of the main reasons why dentists are sued is because the patient’s questions are not answered.102 Evidence also supports the fact that good communication skills are key towards ensuring that patients remain satisfied regardless of the quality of care they receive.103 Patients who feel informed and involved in deciding the most appropriate treatment for their condition are more likely to comply with it and less likely to complain when things go wrong.

Research suggests that there are two sets of factors that influence patients’ decision to sue or seek redress:

  1. predisposing factors – rudeness, delays, inattentiveness, miscommunication, apathy, no communication
  2. precipitating factors – adverse outcomes, iatrogenic injury, failure to provide adequate care, mistakes, incorrect care, systems errors.104

Precipitating factors on their own are unlikely to lead to litigation in the absence of the predisposing factors that build up a patient’s dissatisfaction over time. These predisposing factors can manifest through patient groans and gripes. If you identify these groans or gripes then you should act to respond to these promptly and in an empathetic manner before they have the opportunity to grow into formal complaints. In fact listening effectively and being responsive to non-verbal cues is a COPDEND curriculum competency105 that you are expected to demonstrate during FT. Your attitude to patient complaints should be proactive rather than reactive with your default position being to ask members of your dental team at the end of the day whether any patients made groans or gripes that you could help to resolve.

Having a professional approach to patients’ complaints and accepting responsibility for your actions where appropriate is a COPDEND curriculum competency106 that you are expected to demonstrate during FT. If you receive a complaint, whether written or verbal, you would need to highlight this to your ES. All complaints should be acknowledged quickly, informing the patient when they may receive a formal response. There is then the opportunity to investigate the complaint, identifying all members of the dental team involved and seeking their views before a formal response is drafted. It is at this stage that you may wish to contact your defence organisation. The response should be sympathetic and aim to resolve the patient’s dissatisfaction. Following up the complaint is important, as is reflecting upon the matter.

lightbulbTIP! ‘Sorry’ should not be the hardest word when responding to a complaint. Apologising when something has not gone according to plan is not an admission of liability; therefore, you can be sorry for the dissatisfaction caused. Often that is all that the patient wants to hear.

Trust and goodwill underpin the dentist–patient relationship. Patients have a right to trust their dentist, and as standard 1.3.1 of the GDC’s Standards for the Dental Team107 stipulates:

You must justify the trust that patients, the public and your colleagues place in you by always acting honestly and fairly in your dealings with them.

Research has shown that twice as many people in the UK trust their dentist as their family doctor,108 which sets a strong precedent for you to follow with your patients. This is clearly important, as more than 75% of those surveyed also claimed to follow their dentist’s advice in terms of frequency of visits.

Goodwill is the intangible asset that represents good customer relations and is part of what makes a patient visit you at your practice, and not another. Being friendly and empathetic with your patients helps to build layers of goodwill that can insulate you from potential complaints when the outcome of treatment does not go according to plan. This is where the old adage ‘never treat a stranger’ applies, which incidentally is the best insurance against dissatisfied patients.

Be nicer than necessary to everyone you meet. Everyone is fighting some kind of battle.

—Socrates (470–399 BC)

A common mistake of the FD is to treat patients as if working on a phantom head. We must not forget the service element of dentistry, as it will be the people, not the teeth, who will complain if dissatisfied. Effective communication is key, as asserted by Yamalik109 who identifies the need for dentists to avoid technical language and patronising behaviour. Patients will want to hear about the benefits to them of dental treatment, and not just about the dentistry itself. The use of more basic language as opposed to more technical terms can even be found to reduce anxiety prior to treatment.110

Recovering from complaints

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May 3, 2015 | Posted by in General Dentistry | Comments Off on Dento-legal considerations
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